question for those who've had stitching plus cautery to close puncta

[Guest]

So I saw the lid specialist on Monday (the one who my dr. said he'd even trust his mother with)...

Turns out he's never done a combo cautery/suture to close a puncta. So, he was talking over some options with me...

He was thinking that any kind of dissolvable stitch may not work any better than cautery alone since once the stitch dissolves, what's to stop the puncta from re-opening just like it seems to with cautery alone - makes sense to me since I was wondering the same thing myself.

Figured if he put in a stitch that needed removing, same problem - once he pulls out the stitch, what's to stop the puncta from re-opening like it does with cautery alone... again, makes sense to me since I was wondering the same thing myself.

So he was thinking putting a permanent stitch in could be an option... he'd have to make a small incision to explore for where the drainage passageway from the puncta is, then put in a permanent stitch INSIDE it to hold it shut. I wasn't totally clear on where the cautery part fits in here. ... however, he did say he was leary of doing the cautery/suture at the same time due to possible increased risk of infection. He'd want to do them on 2 separate occasions if I elect to give it a try.

So... in the end, he said if he were me, he'd get the cautery re-done now since I'm there anyhow... if we're lucky and it finally stays shut, awesome. If not, then I can give his office a call and we can possibly do the suture option if I'm comfortable with that.

So, I did the cautery on the pesky upper left puncta for the 3rd time on Monday. Wasn't expecting to, but figured what the heck... I'm not scared of it anymore now that I've been through it a couple times... sure enough, was no big deal. It's now a week later and my left eye is still gloriously wet - loving it - just hoping it lasts!

Soooooo, now that I know he's never done a suture/cautery combo, I'm thinking I'll hold off on the suture thing with him and stick with cautery for now... I don't want to be the pt. he practices on haha (although I certainly appreciate that he heard me out and gave it some serious thought - that was very nice of him so kudos to him for that!!! Also, I totally appreciate his honesty about not having done it before etc... more points for him!)

However, for future reference:

For those of you that had the suture/cautery combo - how did your doc do it? did he cauterize then do the stitch at the opening of the puncta right after at the same visit? (I've heard from some of you that the doc then pulled out the stitch at a later visit)

Did your doc put a stitch somewhere other than the opening of the puncta?

Wondering what was done for you guys...

As always, thanks for reading!

[farmgirl]

Hey Saag: I can't speak to your question but based on your post I have a question for you. On the three occasions that you had the cauterization done, were you not swollen up like you had duked it out with someone whom had caught you with their husband; and you lost. Honestly I couldn't have told you if my eye was moist or not they were so swollen and ugly. By the same token mine are still sealed so I am wondering if they took the cooker out before the timer went off ergo your need for constant repeats...F/G

[DCRdryeye]

Dear SAAG - I haven't had cauterization or suture, so why write? Well, it's because a marvellous compassionate oculoplastic surgeon I consulted in Melbourne (Australia) really wants to cauterize me but I've been against any form of structural change to my lacrimal system, especially if it's not reversible (my story at www.blockedtearductsurgeryadult.com), it maybe some form of PTSD. Anyway, my surgeon said she ALWAYS sutures after she cauterizes to ensures the cauterization doesn't open again. She explained how she has to create a rough edge on the puncta to enable them to join, and had never had a cauterized puncta re-open on her.

I was thinking you could write to her and ask for her technique. If you'd like her details please send me a private message.